Hepatitis

Definition of Hepatitis

Hepatitis is the inflammation of the Liver (Hepa means Liver and itis inflammation). It is an important medical condition which is characterized by the presence of inflammatory cells inside the Liver. It can range from mild to serious illness. In some mild cases it heals itself (Self-Limited) and in some cases it progresses to the severe damage to the organ in form of Fibrosis and Cirrhosis.

Hepatitis often manifests in form of various symptoms however it can exist without any visible change or illness. It is further divided into two types as follows:

Acute Hepatitis: It is the form of Hepatitis which lasts no longer than 6 months.
Chronic Hepatitis: This form of Hepatitis last more than 6 months and persist up to years or even whole life.

Hepatitis is caused by a number of different reasons with Hepatitis Viruses being the most common cause. Others include Toxic Substances and Autoimmune Diseases.

Cause of Hepatitis A

Hepatitis is caused by a number of different reasons with Hepatitis Viruses being the most common cause. Others include Toxic Substances and Autoimmune Diseases. They are further described and classified according to causes as follows:

Viral Hepatitis: It is the form of the Hepatitis caused by the Hepatitis Viruses. They are of five types.

Hepatitis A Virus causes Hepatitis A which is an acute form of the disease.
Hepatitis B Virus causes Hepatitis B. It is mostly acute but can transform into chronic form.
Hepatitis C Virus causes Hepatitis C. It is mostly chronic in nature.
Hepatitis D Virus causes infection only in people already infected with Hepatitis B Virus. It results in acute Liver damage.
Hepatitis E Virus causes Hepatitis E which is similar to Hepatitis A. It is acute form of the disease.

Non-Viral Hepatitis: A number of other causes (other than viruses) can cause Hepatitis in a normal person. They are described and classified as follows :

Alcoholic Hepatitis is caused by excess alcohol consumption. Alcohol consumption in excess causes damage to Liver cells and hence Cirrhosis. This form of Hepatitis usually develops when a man consumes more than 80 grams and woman consumes more than 40 grams of Alcohol in a day for long periods of time. People with Alcohol consumption are at increased risk of developing Hepatitis C. And those already infected with Hepatitis C develop Liver cirrhosis earlier. Alcoholic Hepatitis can range from mild asymptomatic disease to severe Liver damage and failure.

Non Alcoholic Fatty Liver Disease: In this disease patient with no history of Alcohol use develops Fatty Liver (liver with excess fats in cells). This condition is serious and leads to cirrhosis and fibrosis.

Autoimmune Hepatitis: In this form of disease body develops immune cells against Liver cells which act upon and destroy them. It is chronic form and occurs mostly in females.

Toxic and Drug induced form of Hepatitis: People taking excessive drugs like acetaminophen can develop this form of the Hepatitis. Drugs which are hepatotoxic (toxic to liver) cause liver injury hence produce Hepatitis. Certain toxins like Mushroom poisoning are related with Liver injury and Hepatitis as they are hepatotoxic.

Other causes: Hepatitis may occur because of certain other reasons. It may occur due to ischemia induced by injury, shock or sepsis. It can also be caused by idiopathic reasons as Giant Cell Hepatitis in newborns.

Signs and Symptoms of Hepatitis

Signs and Symptoms of the Hepatitis regardless of the cause follow a general pattern. However it is different in its acute and chronic types.

Acute type: Generally viral Hepatitis can be asymptomatic (especially in children). However symptoms start to appear mostly after 7-10 days.

General Flu-like symptoms
Jaundice
Fever, Malaise (rash)
Muscle and Joint Aches
Nausea, Vomiting, Diarrhea
Loss of Appetite
Headache
Dark colored Urine
Hepatomegaly (enlargement of the Liver)
Splenomegaly (enlargement of the Spleen)
Lymphadenopathy (enlarged Lymph Nodes)

It may progress in some individuals rapidly to Acute Liver Failure in which Liver stops performing its functions and becomes non-functional. It is a fatal condition in most cases.

Chronic type: Chronic form of Hepatitis is mostly asymptomatic and symptoms start to appear slowly and at a later stage. These include

Malaise and general Weakness and Tiredness
Jaundice
Liver Enlargement

Excessive damage to Liver at later stages leads to Liver Cirrhosis and Fibrosis. They produce following signs and symptoms:

Weight Loss
Bleeding disorders
Fluid accumulation inside abdomen
Peripheral Edema (swelling of legs and feet etc.)

Eventually it leads to

Confusion and Coma (hepatic encephalopathy)
Kidney dysfunction
Enlarged veins in Esophagus

In Autoimmune Hepatitis there may be acne, lung scarring, inflammation of thyroid and kidneys, abnormal menstrual period.

Risk Factors for Hepatitis

People with following conditions are at more risk for getting hepatitis than others:

Having multiple sex partners
People with chronic liver diseases
Alcoholic persons
People with diabetes above sixty years old
People with kidney diseases
People living in poor sanitation conditions
People drinking contaminated water and food
Females have slower metabolism than males so they are more risk
People with inherited genetic alterations that affect the production and function of liver enzymes
People working in industrial areas are more exposed to toxins that damage liver cells and cause hepatitis
People travelling to other countries which have increased incidence of hepatitis
Paramedical staff is at more risk because they can have contact with the blood of affected people.

Diagnosis of Hepatitis

Diagnosis of Hepatitis requires several Laboratory and Clinical Procedures. They include patient history, physical examination, imaging, lab testing and Liver Biopsy. Lab Techniques are described as follows:

Blood Tests: These are of further many types.
Serology testing is a type of Blood test in which serum of the patient is separated from the rest of the blood via a centrifuge machine. Later this serum is tested for antibodies against specific kind of the Virus. This gives us diagnosis about Viral Hepatitis and its type however it is qualitative only.
Nucleic Acid testing involves identification of viral nucleic acids inside the blood through amplification and identification by machines. It is both qualitative and quantitative in characteristic.
Blood Chemistry testing gives us several properties of the blood. These include several electrolytes, minerals, blood cell counts etc. It is diagnostic in nature as it gives idea about underlying sickness.
Liver Enzymes are a reliable method for diagnosing functioning of the Liver and any damage to it by Hepatitis. In Hepatitis Liver cells are destroyed and release Liver Enzymes hence levels of Liver Enzymes in the Blood are raised in case of damage to the Liver.
Liver Biopsy is a method of obtaining Liver tissue from the body via a syringe and the later observing it under the microscope in the Laboratory. It tells exact morphology and pathology of the Liver Cells. It is a very accurate approach to diagnose Hepatitis; however it includes risk of damage to the Liver itself.

These laboratory techniques are used to diagnose different forms of the Hepatitis. However each type is diagnosed in a different manner.

Viral Hepatitis: Doctor first takes history and then performs physical examination. Jaundice, poor bowel and eating habits etc. are suggestive of Viral Hepatitis. Then serologic testing is performed according to the suspected type of the Hepatitis. If it is positive it is quantitatively diagnosed via Nucleic Acid testing.
Alcoholic Hepatitis: In this form history is quite suggestive with accompanying symptoms like jaundice, weight loss, nausea, malaise etc. It is confirmed via Liver Biopsy.
Toxic and Drug induced Hepatitis : Patient history of drug abuse or coming in contact with toxic material like several industrial workers or mushroom poisoning, is suggestive. It is also diagnosed by Liver Enzyme testing and Liver Biopsy.

Prevention from Hepatitis

Following preventive measures, if taken, can save us from various types of hepatitis :

Prevention from Viral Hepatitis :

Hepatitis A: Vaccination for newborn babies are available to protect them from hepatitis A. Two or three doses are required for them. Adults need booster doses 6 and 12 months after the initial doses. Always wash hands after using the washrooms. Do not eat raw food or vegetables where sanitation conditions are poor. Always drink boiled and filtered water. Do not eat seafood in the area with an increased rate of hepatitis.

Hepatitis B: Hepatitis B can be prevented easily by Vaccination. It is given in childhood two to three times. Adults require booster every year after initial dosage. Do not use already used syringes for blood transfusion. Do not share shaving razors. Do not share toothbrush. Do not touch the spilled blood. Have safe sex. If you need a transfusion of blood, always use tested blood.

Hepatitis C: Do not leave the wound uncovered. Never share your razors, nail clippers and tooth brush. Never use already used needles and intravenous lines.

Hepatitis D: As hepatitis D can be caused only in the people infected with hepatitis B, so take precautionary measures for hepatitis B.

Hepatitis E: Always eat freshly cooked food. Do not eat undercooked food or raw vegetables. Wash hands well after using washrooms.

Prevention from Alcoholic Hepatitis:

Reducing the alcohol consumption can reduce the risk of hepatitis. In addition, one should avoid taking the alcohol along with liver affecting drugs, such as acetaminophen.

Prevention from drug induced Hepatitis:

Always take medicines only when prescribed by the doctor. Avoid over the counter pain relievers as they often contain liver damaging content.

Prevention from Autoimmune Hepatitis:

There is no specific preventive measure to avoid Autoimmune Hepatitis.

Treatment of Hepatitis

Viral Hepatitis: Apart from prevention by Vaccination and elimination by Immune System some types of Viral Hepatitis require proper medication.

Hepatitis A requires no specific treatment. It heals itself spontaneously. However patient must avoid taking other drugs.
Hepatitis B usually requires no treatment. However patient must rest and take carbohydrates to improve liver functioning. If it doesn’t heal as in some cases, it is treated with Interferons (antiviral drugs).
Hepatitis C requires medication. It is treated with Interferons and Ribavirin. Both are antiviral drugs.
Hepatitis D and E cannot be treated effectively with any medication.

Alcoholic Hepatitis: Treatment includes avoiding further Alcohol intake and proper medication for reducing fats inside liver and rehabilitating liver cells. If cirrhosis has occurred Liver Transplant is the only option.

Toxic and Drug induced Hepatitis: Patient with this form of Hepatitis is usually treated by eliminating the source. Toxins and drugs can be washed from stomach by Gastric Lavage. Later they are prescribed antitoxins. For Liver, Corticosteroids can be given.

Autoimmune Hepatitis: Autoimmune Hepatitis is treated generally by anti-inflammatory drugs like Corticosteroids, Antimetabolites, and Immune Suppressing drugs.